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G270 Exam #3 > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

Where to hear S1

A

5th intercostal space, left midclavicular line

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2
Q

What are you hearing when you hear S1?

A

beginning of ventricular systole

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3
Q

Where is it best to hear S2?

A

2nd intercostal space and L or R sternal border

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4
Q

What are you hearing when you hear S2?

A

beginning of ventricular diastole

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5
Q

Click heart sound

A

high pitched tone following S1- improper closing of the valve

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6
Q

Snap heart sound

A

sharp sound following S2- typical with mitral stenosis

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7
Q

What does a murmur indicate?

A

blood back flow through an incompletely closed valve

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8
Q

What do you do when you hear a new murmur?

A

contact provider asap

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9
Q

Main cause of CAD

A

atherosclerosis

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10
Q

What causes atherosclerosis? (2)

A
  • Repeated inflammatory response to artery wall (HTN, T2D, inflammatory diet)
  • Repeat vascular injury to endothelium
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11
Q

CAD path (4)

A

endothelial injury –> fatty streak –> plaque –> complex lesion

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12
Q

What can happen to a complex lesion?

A

May rupture & produce a thrombus – activation of coagulation cascade & platelet aggregation !!!

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13
Q

non-modifiable CAD risk factors (5)

A 
	Family history
	Men > 45 years old
	Women > 55 years old
	Gender
	Race
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14
Q

Modifiable CAD risk factors (9)

A 
	Hyperlipidemia 
	Smoking, tobacco
	HTN, diabetes
	Metabolic syndrome 
	Physical inactivity
	Obesity
	High LDL
	Low HDL
	Resulting atherosclerosis
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15
Q

What are CAD clinical manifestations dependent on?

A

Symptoms depend on location, degree of narrowed vessel, thrombus formation, and obstruction of blood flow to myocardium

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16
Q

CAD clinical manifestations (2)

A
  • angina pectoris

- MI

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17
Q

What is stable angina?

A

Predictable & consistent pain occurring on exertion

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18
Q

How is stable angina treated?

A

o Relieved by rest and nitroglycerin (sublingual  dilates coronary artery)

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19
Q

unstable angina characteristics (4)

A

o Symptoms increase in frequency & severity, often at rest
o May NOT be relieved by rest and nitroglycerin
o EKG may be Normal, or T inversion
o Normal troponins

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20
Q

What is silent ischemia?

A

o Objective evidence of ischemia but patient is asymptomatic

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21
Q

which population is most at risk for silent ischemia?

A

elderly population

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22
Q

Angina medical management –> which medication class is given for immediate alleviation of pain?

A

Nitrates

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23
Q

angina medical management- nitrates (3)

A
  • nitroglycerin
  • nitrobid
  • nitrostat
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24
Q

angina medical management- beta blockers (2)

A
  • metoprolol

- atenolol

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25
Q

angina medical management- calcium channel blockers (2)

A

-amlodipine, diltiazem

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26
Q

angina medical management- anti platelet medications (3)

A

o ASA, clopidogrel (Plavix), prasugrel (Effient)

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27
Q

angina medical management- anticoagulants (5)

A

o Unfractionated heparin, enoxaparin, apixaban, rivaroxaban, fondaparinux,

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28
Q

Nitroglycerin ointment steps (4)

A
  1. Wear gloves when removing old application and applying new application to prevent the development of headache
  2. Remove previous nitroglycerin ointment and applicator paper and fold in half before disposing in trash
  3. Apply new ointment on a different site
  4. Do not massage; secure, date time and initials
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29
Q

CAD Prevention (5)

A
  • lower cholesterol
  • stop smoking
  • lower BP
  • control T2D
  • increase activity
30
Q

What is an important question to ask when a male comes in with chest pain regarding their medications?

A

if they are on erectile dysfunction medications

31
Q

CAD diagnostic studies (6)

A
  • 12 lead ECG
  • holter monitor
  • exercise tolerance test (stress test)
  • nuclear stress test/pharm stress test
  • echo
  • TEE
32
Q

What does the holter monitor detect?

A

dysrhythmias

33
Q

Exercise tolerance test (stress test)

What does it do?
what to monitor
-stressed via ___ if patient cannot tolerate exercise

A
  1. Exercise to increase demand on heart
  2. Stressed via drugs (e.g., adenosine) if patient cannot tolerate exercise
  3. Monitoring vital signs, ECG
34
Q

Nuclear stress test

A
  1. Dilation of normal coronary arteries
  2. Radioactive isotopes are injected
  3. Done w/echo or radionuclide scintigraphy
  4. For patients unable to tolerate other types of stress tests
35
Q

Geriatric considerations (4)

A

 Diminished pain transmission: may not exhibit typical pain
 Often no symptoms-silent MI
 CAD diagnosis: pharmacologic stress test and cardic cath lab
 Use medications cautiously: increased risk of adverse reactions

36
Q

causes of acute coronary syndrome (5)

A
  1. Atherosclerosis
  2. Emboli
  3. Blunt trauma
  4. Spasm
  5. Aortic dissection
37
Q

2 types of MI

A

STEMI and NSTEMI

38
Q

Pt has s/s ACS with an ST elevation.. what do they have?

39
Q

Pt has s/s ACS with elevated troponin and normal ECG..what is it?

40
Q

Pt has s/s ACS with normal troponin and normal ECG..what is it?

41
Q

Is a STEMI caused by a total block or partial block?

42
Q

AMI symptoms (9)

A 
	Midsternal chest pain
	SOB
	Pale and diaphoretic
	Nausea and vomiting
	Dysrhythmias
	Dyspnea, tachypnea, hypotension
	Syncope
	Feeling of impending doom
	Anxious/restless
43
Q

AMI midsternal chest pain characteristics (3)

A
  1. Severe, crushing, and squeezing pressure
  2. May radiate
  3. Unrelieved with nitrates
44
Q

women s/s AMI (9)

A 
	Women may have atypical S/SX:
	Fatigue
	SOB
	Diaphoresis
	Indigestion
	Arm/shoulder pain
	Upper back
	N/V
	Jaw pain
	SILENT MI - may have No S/S in the presence of ECG changes and increased troponin level
45
Q

normal troponin levels

A

< 0.04 ng/ml

46
Q

AMI Labs–> troponin characteristics

A
  • Elevated within a few hours of heart damage and remain elevated for up to two weeks
  • A rise and/or fall trend: heart attack
47
Q

AMI Labs–> CK-MB characteristics (4)

A
  • Appears 4-6 hours after symptom onset
  • Peaks at 24 hours
  • Returns to normal in 48-72 hours.
  • May be of use in case of reinfarction (rises again)
48
Q

AMI Labs –> Myoglobin

A
  • Typically rises 2-4 hours after onset of infarction
  • Peaks at 6-12 hours
  • Returns to normal within 24-36 hours
49
Q

AMI interventions –> what to do first

A

MONA!! Morphine, oxygen, nitroglycerin, ASA

50
Q

AMI interventions –> what is done after MONA (4)

A
  • Beta blocker
  • ACE inhibitor within 36 hours
  • anticoag w/ heparin and platelet inhibitors
  • statin
51
Q

Nursing care: ER Chest pain –>. assessment

A

CV, respiratory (crackles), allergies to dye or shellfish, ED meds

52
Q

What needs to be closely monitored for a patient on IV drip nitrgoglycerin

A

BP (hypotension may occur)

53
Q

CODE STEMI

A
  • 12 lead ECG within 10 mins of arrival
  • activate code STEMI
  • less than or equal to 12 hours since symptom onset: stat trop, MONA, prepare for cath lab
54
Q

AMI Complications (7)

A 
	Dysrhythmias
	Sudden death
	Heart failure
	Cardiogenic shock
	Ventricular aneurysm or rupture
	Aneurysm
	Papillary muscle dysfunction or rupture
55
Q

door to cath lab time frame

56
Q

door to fibrolytics (needle) time frame

57
Q

when can PCI or thrombolytic therapy be used?

A

less than 12 hours of onset of pain

58
Q

when is thrombolytic therapy used instead of PCI?

A

if PCI is unavailable

59
Q

PCI interventions –> intracoronary stenting (4)

A
  • Metal mesh to keep vessel open & prevent restenosis
  • Drug-eluting option to minimize formation of thrombi or scar tissue
  • ASA indefinitely
  • Anti-platelet drug clopidogrel (Plavix) for 1 year
60
Q

post-catheterization care for groin approach

A

• Lay flat 4-6 hours depending on intervention (may require reverse Trendelenberg)

61
Q

post-cath care –> radial approach

A

2-4 hours immbolized hand (TR band): focused assessment?  bleeding, neurovascular assessment (Sensation, Movement, Circulation)

62
Q

Post cath general care (3)

A

 Monitor for vascular hemostatic device and site for bleeding or hematoma
 Monitor VS, patient, pulses: neurouvascular assessment
 May be discharged in 6 to 8 hours; depends on diagnosis and procedures done in catheterization laboratory

63
Q

If interventional Cardiac cath lab unavailable or patient not candidate –> fibrinolysis ….nursing interventions (6)

A 
	Type and crossmatch blood
	3 large bore IV’s
	Cardiac monitor
	Administer < 12 h from event
	Follow with heparin
	Monitor for s/s of bleeding
64
Q

when is someone a candidate for CABG?

A

 At least 70% occlusion or any coronary artery or 50% of left main coronary artery

65
Q

CABG indications (4)

A
  • Alleviation of angina not controlled by PCI
  • Left main artery stenosis or multivessel disease
  • MI, dysrhythmias or heart failure
  • Complications from unsuccessful PCI
66
Q

increased mortality rate from CABG associated with: (6)

A
  • Left ventricle dysfunction
  • Emergency surgery
  • Age
  • Gender (female)
  • Number of diseased vessels
  • Decreased EF with CHF
67
Q

CABG Complications (5)

A
  • dysrhythmias
  • low CO
  • pericardial tamponade
  • hypovolemia
  • shock
68
Q

Pericardial tamponade causes ____

69
Q

Pericardial tamponade: BECKS TRIAD

A
  • distended neck veins
  • muffled heart sounds
  • hypotension
70
Q

pericardial tamponade –> ECG Changes

A

causes electrical alternans

71
Q

if pt on heparin drip what lab needs to be monitored

72
Q

if patient on warfarin what lab needs to be monitored?

G270 Exam #3 (2 decks)

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